Angiographic Demonstration of Intrahepatic Arterio-Portal Anastomoses in Hepatocellular Carcinoma

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Abstract
Hepatic angiograms of 114 patients with hepatocellular carcinoma (HCC) were studied, particularly changes in the portal vein branches. Arterioportal shunts of varying sizes, evidenced by opacification of intrahepatic portal branches, were seen in 72 cases (63.2%), with retrograde opacification of the portal vein trunk in 29 (25.4%). At least 4 types of shunts were found: through a tumor thrombus in the portal branch, in a retrograde direction via a peripheral tumor nodule, through a small tumor invading or amputating an artery and through a tumor located near a major portal vein branch and supplied by a large, coiling artery. Postmortem angiography of the liver in 50 patients with HCC suggests that arterioportal shunts are the result of the special vasculature in HCC and are diagnostic when accompanied by other angiographic changes.